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today, and who is frequently the chairman of the clinic or the clinic director; surgeons, X-ray and radium therapists and diagnosticians; and where they are available, other medical specialists such as skin specialists, gynecologists, and others. These men get together collectively to consider the problems of individual patients with cancer, because again the complexity of this disease is so great that it has been recognized that this group opinion is a very effective way to solve many of the problems. So they offer the services of diagnosis and treatment to patients with cancer.
Mr. CARLYLE. As contrasted with chart 15, where cancer-detection centers are located. You say, then, that chart 15 would indicate where the cancer center is located, where the cancer can be detected; and chart 17 represents the location of clinics where the cancer can be treated.
Dr. CAMERON. Approximately, yes; diagnosed and treated. We make a distinction between detection and diagnosis, Mr. Carlyle, because detection is looking to see if it is there and diagnosis is finding out what it is you are looking at.
The CHAIRMAN. Any further questions, gentlemen?
The CHAIRMAN. Mr. Roberts.
Mr. ROBERTS. Doctor, in your statement you mentioned that there has been a great increase in the particular type of cancer known as lung cancer. Have any conclusions been reached by the profession as to why that is true?
Dr. CAMERON. I would say no conclusions, because the matter is still under very careful scrutiny. I will say that in the past 5 years there has been an enormous increase in the research interest directed at this problem and in the epidemiologic studies, which are making the facts clearer that there is in this increase; and the studies which are trying to identify it with one of the external environmental causes which I mentioned in my original presentation. I think there are no conclusions. I think there are growing suspicions.
Mr. ROBERTS. What age group does seem to have the greatest number of cases? In what age group is that?
Dr. CAMERON. It is certainly commonest in those from 50 to 70, but it appears slightly earlier than most cancer.
Mr. DEROUNIAN. Would the gentleman yield on that?
I seem to be a "bug" on this question of nicotine, but we have doctors back home who have sort of impressed me with this fact, and I want to know whether it is true from your standpoint: That lung cancer is on the increase and the increase has been more predominant in the women as against the men; and, as regards lung cancer 25 years ago and today, the increase has been so great in the women that there is pretty concrete proof, this fellow says, that it may be due to smoking, that women who smoke cigarettes may inhale and that is a cause of greater lung cancer, and the men have not had such an increase because a lot of men smoke pipes and cigars and they do not inhale pipes and cigars? Is there more than a suspicion from your investigation as to the truth of that statement?
Dr. CAMERON. Well, you are directing that to me? I mean, there are other people here.
Mr. DEROUNIAN. I know the cigarette manufacturers are interested in this.
The CHAIRMAN. I think maybe the reason Dr. Cameron asked if you were directing that to him is this: I think, from what I understand, that Dr. Rhoads has made a particular study of that.
Dr. HELLER. Dr. Rhoads?
Mr. DEROUNIAN. Anyone at all who wants to answer.
Dr. CAMERON. I will say this: If we are to be serious about this and spend more time on it, I think it will be necessary to correct one of your premises. I think the increase has not been predominatly in women. I think the reverse is true. At the turn of the century they used to say that there was one female cancer of the lung for every four male cancers of the lung. Today they fix the difference very much wider. The generally accepted figure is 1 female for every 8 or 9 or 10 males
There have been about 10 or 12 studies which have shown that the rate of heavy smoking is higher in men with cancer of the lung than it is in control groups. These control groups have been almost without exception from hospital populations. There are many defects with this type of study. I barely understand it myself, not being a statistician by training.
But I do want to say, in advance of the evidence which Dr. Rhoads may be willing to give, that we regard this as a most important fact to establish or to deny; the relationship of smoking to cancer
The American Cancer Society undertook a year and a half ago a study which now involves 210,000 males in the United States between the ages of 50 and 69. Those men are known to us. They are all on punch cards in our offices in New York. We have their smoking histories. We know how they have smoked for the past 40 years, and we have a lot who did not smoke.
The essential thing was to get men who were well between 50 and 69 and whose smoking histories we could accurately record. We have all that information. Now every time one of those men dies the fact is reported to us. We certify the cause of death with the local department of health and that is recorded on his punchcard. From here on, whenever we have a slack afternoon we run the cards through to see whether the men with heavy smoking histories are dying of cancer at a faster rate than those who do not smoke. It is going to take another year and a half to get answers with any degree of certainty, but I am sure we will have them in a way that will satisfy you.
The CHAIRMAN. If you will permit, Mr. Derounian, I would like to say that I am awfully sorry I did not know about this before I assumed the responsibility of stopping smoking. Maybe I could have been one of those 210,000 you would have checked up on, and maybe I could have been saved this task of trying to stop smoking. Dr. CAMERON. Well, it may not be too late to include you. The CHAIRMAN. Had you finished?
Mr. DEROUNIAN. I was just wondering whether Dr. Rhoads had anything on this point that he wishes to speak to.
Dr. RHOADS. Mr. Chairman, I think Dr. Cameron has dealt very adequately with the epidemiologic study of lung cancer and its relation to smoking. My interest is derived from the presence on my staff of Dr. Winder, who, with Dr. Graham, of St. Louis, made perhaps the first convincing statistical study which developed information strongly suggesting a relationship between the smoking of cigarettes and the occurrence of lung cancer.
The rate of occurrence is much greater in men than in women. rate of increase is greater in men than in women. Our figures are nearer 20 to 1 than the 5 to 1 quoted by Dr. Cameron, but they vary from clinic to clinic.
There are no less than 11 publications which have confirmed the findings of Drs. Winder and Graham. So adequate is the confirmation that we have felt compelled to do what could be done to stimulate further studies of this matter.
I am a consultant to certain studies presently under way at New York University. Part of the study is at our own institution. A very serious effort is going forward to investigate the constituents present in cigarette smoke and tobacco smoke in general and in other sources of air pollution. Machines have been devised for mechanically smoking cigarettes in a manner and under physical circumstances as nearly simulating those which humans use in smoking as possible.
The tars so derived have been collected and have been shown to be productive of cancer in mice and in rabbits. We have chemists working on the problem, and these chemists have divided these tars into certain pure fractions which are presently under test in experimental animals, and certain tests have been made upon the skin of human volunteers, or at least a human volunteer, to ascertain whether there can be induced changes which would suggest that some chemical part of the cigarette tar may be implicated as one factor among several factors in the etiology, the cause of lung cancer.
In short, I am suspicious that there is a relationship. I am sure smoking is not the only factor, from the evidence. We are doing all we can do to establish the factor in smoking, if there, and to get it out of there by some mechanical filtration or chemical neutralization means. I do not believe we can stop the population from smoking. Dr. HELLER. Mr. Chairman, a further possible elucidation of this particular problem: In collaboration with the Veterans' Administration we are starting a study of one-third of a million, approximately, veterans of World War I to ascertain their smoking habits and to obtain from the death certificates subsequently the fact as to whether or not this does represent the same high correlation which has obtained in other studies; so that studies are under way in an attempt to illuminate this particular very difficult question.
The CHAIRMAN. Off the record.
(Discussion off the record.)
The CHAIRMAN. Now, gentlemen, are there any other questions? I do not know whether it comes within this particular phase of our inquiry, which we are now engaged in, but it came to my attention that Dr. Rhoads, who has assisted us so splendidly this morning, and who will continue to do so, has even permitted himself to be a sort of a guinea pig, if an intelligent man can be characterized that way, in permitting certain tests to be made, which he is undergoing, of one kind or another.
Is there something to that, Doctor, which would have any bearing on the question of nicotine; or are your experiences along some different lines? I understood you had submitted yourself to certain tests that are being made and observed day by day. Is that true?
Dr. RHOADS. Well, I think I really ought to invoke the fifth amendment here.
The CHAIRMAN. I beg your pardon?
Dr. RHOADS. I think I ought to invoke the fifth amendment. The CHAIRMAN. Well, I am sure you have a better reason for it than some others.
Dr. RHOADS. I hope so. The answer, sir, is that
The CHAIRMAN. I know it is your modesty which takes advantage of the fifth amendment.
Dr. RHOADS. Well, all through my scientific life I have taken part actively in tests of various compounds. I have not had tests made upon me which would be hazardous or which I would hesitate at all in having made upon relatives or patients, if they care to have them made. It is only a part of the day-to-day routine, sir. It is nothing of any consequence.
The CHAIRMAN. I thought the committee would be interested in knowing this fact about Dr. Rhoads, who is extremely modest in his statements with reference to it. Maybe I can elaborate more upon it when I talk to the members of the committee individually, but it certainly is pleasing to have one as a witness here today who is personally so interested in the subject on which he testifies that he is willing to go to great lengths to be helpful to the profession and to others. We admire Dr. Rhoads for that.
Mr. WILLIAMS. Mr. Chairman?
The CHAIRMAN. Mr. Williams.
Mr. WILLIAMS. I have one more question I would like to ask.
I wonder if you have conducted any studies or if you have any information on which to base a conclusion as to whether or not the incidence of cancer is greater in urban areas or in rural areas, or if there is any difference?
The reason I ask that is this: I wonder if possibly the breathing of industrial fumes and poisons, and so forth, in the cities might be a contributing factor to a higher cancer rate in the cities than in the country?
Dr. CAMERON. It is very seriously regarded. The rate of cancer of the lung is consistently higher in urban areas than in rural areas. A recent study from England has indicated that it is higher in that part of the city which is exposed to the byproducts of a nearby coke factory than it is in other parts of the city.
The subject of atmospheric pollutants is being worked on with increasing interest, and studies are presently under way to test various atmospheric fractions from smog-smitten cities such as Los Angeles in a effort to find what cancer-inciting role they may have.
Mr. ROBERTS. Mr. Chairman?
The CHAIRMAN. Mr. Roberts.
Mr. ROBERTS. I would like to know if any members of the panel have prepared any comparative figures which would show what we spend, for instance, for agricultural research, for research on animals, as compared to what we are spending for cancer research.
Dr. HELLER. Mr. Roberts, I am not sure that we have those exact data available for you. However, we shall attempt to get them and put them in the record if you desire.
Mr. ROBERTS. I would like to have those, if you can get them for me. (The information is as follows:)
COMPARATIVE FIGURES ON CONTROL OF ONE ANIMAL DISEASE AND AGRICULTURAL RESEARCH COMPARED TO COST OF CANCER RESEARCH
According to the Albert and Mary Lasker Foundation, Inc., the United States Department of Agriculture authorized the spending of $32,701,700 for control of hoof-and-mouth disease in a single year in Mexico as compared with the $18,621,655 spent for cancer research during fiscal year 1953.
The Department of Agriculture reports that more than $212 million was spent in the past year on agricultural research, $112 million by the Government and more than $100 million by private industry.
Dr. CAMERON. May I add something, Dr. Heller?
Dr. HELLER. Certainly.
Dr. CAMERON. We have that data in New York, and we would be glad to submit it in addition to what Dr. Heller does. We deliberately left it behind because every time we have used figures of that kind before congressional appropriations committees it has created a high offense.
Mr. ROBERTS. I do not know what it would create, but if it will create more interest in this problem I think we are all for it. The CHAIRMAN. Any further questions, gentlemen? Mr. ROBERTS. That is all, Mr. Chairman.
The CHAIRMAN. If not, we have arrived at a time when it would be appropriate probably to stop and have a recess. There is a lot to be covered, I will say to the committee, this afternoon as a result of our long questioning this morning. It has put our schedule back a little bit, so that I hope when we adjourn now until half past 1 that the members of the committee will meet promptly so that we can proceed with diligence this afternoon.
(Thereupon, at 12:30 p. m., Friday, October 2, 1953, a recess was taken until 1: 30 p. m. of the same day.)
(The committee reconvened at 1:30 p. m., pursuant to recess.) The CHAIRMAN. The committee will come to order. Will you proceed, Dr. Heller?
Dr. HELLER. Thank you, Mr. Chairman. I think it is important to stress the element which I mentioned this morning, that it requires teamwork, liaison, and exchange of ideas and intelligence in order to do the job with which we are charged, to do it economically, to do it as efficiently and as effectively as we can. I have asked Mr. Mefford Runyon, executive vice president of the American Cancer Society, to speak briefly to this point.
The CHAIRMAN. Mr. Runyon.
STATEMENT OF MEFFORD R. RUNYON, EXECUTIVE VICE
Mr. RUNYON. Mr. Chairman, may I enter some proposed materials for the record?
The CHAIRMAN. Without objection, it is so ordered. (The materials referred to follow :)